メディケア医師グループ実務デモに関連する支出の差異
Carrie H Colla1, David E Wennberg, Ellen Meara
1Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 35 Centerra Pkwy, Lebanon, NH 03766, USA. Carrie.H.Colla@Dartmouth.edu
JAMA
|September 13, 2012
まとめ
Medicare Physician Group Practice Demonstration (PGPD) は,全体的なコスト削減が控えめで,メディケアとメディケイドの双重資格を持つ受益者に集中した大幅な節約が示されました. 参加した医師グループの中には,かなりの節約を達成した医師グループもあれば,そうでない医師グループもいた.
科学分野:
- 健康経済学 医療経済学
- 保健医療政策について
- 医療の質の向上 医療の質の向上
背景:
- メディケア・メディケイド・サービスセンター (CMS) は,医療の質を向上させ,費用を管理するために,アカウンタブル・ケア・オーガナイゼーション (ACO) プログラムを導入しました.
- Medicare Physician Group Practice Demonstration (PGPD) のパイロットはACOに先立ち,医師団が質目標を達成し,コストを削減するために金銭的インセンティブを提供しました.
- PGPDは質の改善を示したが,医療費への影響は不明であった.
研究 の 目的:
- PGPDの全体的なコスト削減を決定する.
- メディケアとメディケイドの双重資格を持つ受益者のためのコスト削減を具体的に推定する.
主な方法:
- 介入前 (2001-2004) と介入後 (2005-2009) の支出動向を比較した準実験的な設計が採用されました.
- 介入グループには,PGPD医師が治療した990,177人の有料メディケア受給者;対照グループは,同じ地域から7,514,453人の受給者を含む.
- 受益者一人当たりの年間支出が主な成果指標であり,ケースミックス分析には様々なリスク調整方法が使用されました.
主要な成果:
- 総額として,受給者一人当たりの年間貯蓄は控えめでした (調整平均114ドル).
- 相当な節約は,二重資格の受給者 (532ドルの調整された平均値) に見られたが,二重資格の受給者でない受給者には見られなかった.
- 支出削減は主に急性ケアで,参加医者のグループ間で貯蓄の顕著な変動がありました.
結論:
- PGPDは一部の機関で大幅な節約を達成しましたが,これは他の機関での節約の欠如によって相殺されました.
- ほとんどのコスト削減は,メディケアとメディケイドの双重資格を持つ受益者の間で実現されました.
- 調査結果は,医療費に対する実践に基づく支払いモデルの異質な影響を強調しています.
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